Provider Demographics
NPI:1669667796
Name:PICO-LARRALDE, DANET (MD)
Entity Type:Individual
Prefix:DR
First Name:DANET
Middle Name:
Last Name:PICO-LARRALDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 HARDEE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3555
Mailing Address - Country:US
Mailing Address - Phone:305-608-3910
Mailing Address - Fax:
Practice Address - Street 1:434 HARDEE RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3555
Practice Address - Country:US
Practice Address - Phone:305-608-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine